BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.316 of 2016

Date of Instt. 22.07.2016

Date of Decision: 19.06.2018

Chander Parkash Ohri son of Sh. Dina Nath Ohri, resident of 117 A/4, Kamal Vihar, Near Shiv Mandir, Jalandhar.

..........Complainant

Versus

1. Union of India through the General Manager, Northern Railways, Baroda House, New Delhi.

2. Northern Railways, through its Divisional Manager, Ferozepur Division, Ferozepur.

3. Station Superintendent, Northern Railways, Railway Station, Jalandhar.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before: Sh. Karnail Singh (President)

Smt. Harvimal Dogra (Member)

Present: Sh. Arun Gupta, Adv Counsel for the Complainant.

Sh. RK Saddi, Adv Counsel for the OP No.1 to 3.

Order

Karnail Singh (President)

1. This complaint is presented by the complainant, wherein alleged that the complainant was working as Railway Guard and he retired from service on 31.12.2013. A sum of Rs.37,127/- was recovered from the complainant out of the death-cum-retirement gratuity, vide No.729E/29/857 Pen for issuance of Medical Card under RELHS for whole life and medical card No.052136 to this effect was issued to the complainant. On 25.11.2013, the complainant along with his wife while going on Scooter, met with a road accident and sustained head injury and immediately the complainant along with his wife were admitted in the Hospital namely NIMS Pvt. Ltd, Adarsh Nagar, Kapurthala Chowk, Jalandhar, where the surgery of brain of the complainant was conducted by the doctors and the complainant remained admitted in the Hospital till 11.12.2013 and was discharged on 11.12.2013. After discharging from the Hospital, the complainant informed the OPs about the treatment done in the Hospital namely NIMS Pvt. Ltd., Jalandhar and submitted the reimbursement claim for sum of Rs.2,73,815/- along with all the medical bills and treatment prescriptions.

2. That thereafter, the bill scrutiny statement was prepared by the Railways by the Scrutinizing Officer, Northern Railways, Jalandhar and he calculated the amount only for Rs.50,715/- as reimbursement amount. Thereafter, the complainant wrote a letter to the OP No.2. That thereafter, the OP No.2 considered the case of the complainant in the Emergency Committee and recommended that there was emergency for treatment/admission of the complainant in NIMS Hospital, Jalandhar and considered it justified, vide finding dated 28.11.2014. The OP No.1 issued a letter dated 02.07.2015 to the OP No.2 to look into the reimbursement claim of the complainant and clearly stated in the letter that why only package rate has been given and where is non-package rate. Thereafter, the OP No.1 granted sanction of Rs.81,254/- against the claim of Rs.2,73,815/- on account of reimbursement claim of the complainant, vide letter dated 26.02.2016. The complainant wrote a letter to the Chief Medical Director, Northern Railway, Baroda House, New Delhi for reimbursement of the remaining amount i.e. Rs.1,92,561/-. The OP No.1, vide its letter dated 14.06.2016 stated that total amount of Rs.81,254/- has been given to the complainant for reimbursement expenditure incurred on his treatment as per CGHS rates. The OP No.2 issued a letter dated 16.06.2016 to the complainant stating that it was a case of Non-Referred to Non-Recognized Hospital, the reimbursement claim has been calculated as per CGHS 2010 Chandigarh rates for Non-NABH Category.

3. That the complainant remained admitted in the Hospital for 17 days i.e. from 25.11.2013 to 11.12.2013 and spent a sum of Rs.2,73,815/- for his treatment and only a reimbursement of Rs.81,255/- has been allowed by the OPs and denied the reimbursement of the remaining amount of Rs.1,92,561/-, thus, the OPs have resorted to unfair trade practice. Due to non-reimbursement of the remaining amount of the treatment, the OPs are jointly and severally liable to reimburse the remaining amount along with compensation for mental agony suffered by the complainant and as such, the present complaint filed with the prayer that the complaint of the complainant may be accepted and OPs be directed to reimburse the remaining amount of Rs.1,92,561/- along with interest @ 18% per annum and further OPs be directed to pay compensation of Rs.50,000/- and litigation expenses of Rs.5500/-.

4. Notice of the complaint was given to the OPs and accordingly, all the OPs appeared and filed written reply and contested the complaint by taking preliminary objections that the complaint of the complainant is hit by principal of mis-joinder and non-joinder of necessary parties, in case of dispute against Central Government, where it relates to a Railway, then Union of India is to be impleaded through the General Manager of the concerned Railway and even the case of the complainant is also bad for non-serving of notice u/S 80 CPC and even no cause of action arose against the answering OP. It is further alleged that the complainant is barred, estopped and precluded from filing the present complaint by their own acts of admission, commission and omission and even the complainant has no jurisdiction to file the present complaint. It is further alleged that the complainant has suppressed the material facts from the Forum and as such, the complainant is not entitled for the relief as claimed rather the complaint is liable to be dismissed. The real fact is that the reimbursement claim was prepared by Sr. Divisional Medical Officer Jalandhr and calculated as per CGHS 2010 Chandigarh rates for Non-NABH category. Since, this is a medical reimbursement claim of non-referred to non-recognized hospital as per Railway Board Policy dated 31.01.2007 and as such, only CGHS rates are admissible in such cases. On merits, the factum in regard to submitting a bill and reimbursement of the part payment is reply as a matter of record. The allegations as made by the complainant are categorically denied and lastly prayed that the complaint of the complainant is without merits and the same may be dismissed.

5. In order to prove the case of the complainant, counsel for the complainant tendered into evidence affidavit of the complainant Ex.CA alongwith some documents Ex.C-1 to Ex.C-84 and closed the evidence.

6. Similarly, counsel for the OPs tendered into evidence affidavit Ex.OP/A and document Ex.OP/1 and closed the evidence.

7. We have heard the learned counsel for the respective parties and also gone the case file very minutely.

8. In nutshell, the complainant alleged that he was working as a Railway Guard and he retired from the service on 31.12.2013 and at that time, medical card No.052136 for whole life has been issued to the complainant and copy of the same is proved on the file Ex.C-1, whereby a medical treatment has been provided to the complainant as well as to the dependent i.e. the family of the complainant. On 25.11.2013, unfortunately the complainant with his wife met with a road side accident and sustained head injury and thereafter, the complainant with his wife were admitted in the Hospital namely NIMS Pvt. Ltd, Adarsh Nagar, Kapurthala Chowk, Jalandhar, where a surgery of brain of the complainant was conducted by the doctor and complainant remained there admitted from 25.11.2013 to 11.12.2013 and after discharging there from, he informed the OP about the treatment from private hospital i.e. NIMS Pvt. Ltd, Jalandhar and also submitted reimbursement medical claim bill for an amount of Rs.2,73,815/-, but out of that amount, only Rs.81,254/- was sanctioned to the complainant on the flimsy ground. Thereafter, the complainant sent a letter to the OP for reimbursement of remaining amount i.e. Rs.1,92,561/-, the letter sent by the complainant is available on the file Ex.C-13, but all in vain and as such, necessity arose to file the present complaint for getting a remaining medical treatment amount of Rs.1,92,561/- along with interest as well as compensation and litigation expenses.

9. The case of the complainant has been meeted out by the OP simply on the plea that the reimbursement claim of the complainant was prepared by the Senior Divisional Medical Officer, Jalandhar and calculated as per CGHS 2010, Chandigarh rates for NON-NABH category. Since, this is a medical reimbursement claim of non-referred to non-recognized Hospital as per Railway Board Policy letter No.2005/H/6-4 policy 11 dated 31.01.2007 as such, only CGHS rates are admissible in this case and accordingly, the payment was calculated and transferred to the account of the complainant. In support of its version, the OP has brought on the file affidavit of Dr. Amarendra Chatterjee, Chief Medical Superintendent, Northern Railway, Ferozepur, the same is Ex.OPA and photostat copy of the letter of the Government of India dated 31.01.2007 Ex.OP/1.

10. We have sympathetically considered the version of both the parties and find that the officer of the OP itself considered the case of the complainant as an emergency medical treatment and when situation is so, then the case of the complainant will not cover under CGHS rates. For reference, we like to refer the letter produced on the file by the OP i.e. Ex.OP/1, wherein sub-para of the para No.1, itself explained that no one can get treatment from any private hospital himself or their dependents on their own expect. The reference of the Railway doctor, but there is one exception of this embargo, which is as under:- “except in case of the real emergency situation.” We find that case of the complainant is covered under the Real Emergency Situation, for that purpose, we take an opportunity to refer the document prepared and issued by the OP itself i.e. the finding of the Recommendation Committee, the same is Ex.C-7, which is recommended and signed by the penal of the doctors and wherein categorically observed as under:- “Based of these documents and in the light of Railway Board's Policy dated 31.01.2007, emergency for treatment/admission of Sh. Chander Parkash Ohri in NIMS Private Hospital, 221 Adarsh Nagar, Near Kapurthala Chowk, Jalandhar is considered justified”. Not so there is an other finding of the emergency committee for deciding reimbursement of medical expenses of the complainant, the said finding is Ex.C-8, wherein again categorically admitted that the case of the complainant is covered under Emergency Service and further, the official of the OP i.e. Dr. Shashi Bhushan sent a letter to Chief Medical Superintendent, Northern Railway, Firozepur that the medical treatment bill of the complainant is non-package rate, despite this letter, the OP has calculated the amount of the medical bill of the complainant on the basis of package rate and accordingly, allowed the complainant to get reimbursement of Rs.81,254/-, vide letter dated 26.02.2016 Ex.C-10 and against that letter, the complainant again sent a letter to the Chief Medical Director, Northern Railway, Baroda House, New Delhi, the same is Ex.C-13, whereby make a request for making payment of the entire medical expenditure incurred upon his treatment i.e. Rs.2,73,815/-, but the OP did not bother.

11. The OP has also raised an issue that the complaint of the complainant is bad for mis-joinder and non-joinder of necessary party as Union of India is required to be impleaded through the General Manager of the Railway Department and even notice under Section 80 CPC has not been served upon the OP prior to filing the complaint and further challenged the jurisdiction of this Forum.

12. We have considered the aforesaid plea and find that the provision of Civil Procedure Code is not applicable in the present complaint filed under the 'Consumer Protection Act' and as such, the Union of India is not a necessary party and further notice under Section 80 CPC is also not required to be served to the OP prior to filing the instant complaint rather the said notice is compulsory in a civil case. Further, the learned counsel for the OP failed to satisfy this Forum how the jurisdiction of this Forum is barred to file the present complaint. So, with these observations, we are of the considered opinion that the aforesaid issue raised by the OP is without any merits.

13. If, we conclude the case of the complainant on the basis of above discussion, then there remains nothing to say that the amount of medical treatment of the complainant has been wrongly calculated by the OP, whereas as per own letter of the OP, the case of the complainant covered under emergency services and whenever there are any emergency services, then the employee can get treatment from any private hospital and emergency case of the complainant has been considered and found justified by the officer of the OP, vide letter Ex.C-7 and Ex.C-8 and thus, we find that the complainant is entitled for the relief as claimed.

14. As an upshot of our above detailed discussion, the complaint of the complainant succeeds and the same is partly accepted and OPs are directed to reimburse the remaining medical treatment amount of Rs.1,92,561/- with interest @ 12% per annum from the date of filing complaint, till realization and further, OPs are directed to pay compensation for mental agony and harassment to the complainant, to the tune of Rs.15,000/- and further OPs are directed to pay litigation expenses to the complainant, to the tune of Rs.5000/-. The entire compliance be made within one month from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.

15. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated Harvimal Dogra Karnail Singh

19.06.2018 Member President